Provider Demographics
NPI:1467503599
Name:RANCOURT, CARRIE L (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:RANCOURT
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03592-7214
Mailing Address - Country:US
Mailing Address - Phone:603-246-3490
Mailing Address - Fax:
Practice Address - Street 1:181 CORLISS LN
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3207
Practice Address - Country:US
Practice Address - Phone:603-237-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH142133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30047YOtherANTHEM RAN
NH30047YOtherANTHEM RAN